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Comparing the SF-36 and SF-12 in Psychometric Properties as Measuring Quality of Life among Adolescent in China: a Large Sample Cross-sectional Study Yanwei Lin Guangdong Medical University Yulan Yu Guangdong Medical University Jiayong Zeng Guangdong Medical University Xudong Zhao Tongji University Chonghua Wan ( [email protected] ) Guangdong Medical University https://orcid.org/0000-0002-4546-0620 Research Keywords: Quality of Life; Reliability; validity; Discrimination; Average Information Posted Date: April 3rd, 2020 DOI: https://doi.org/10.21203/rs.3.rs-19671/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on November 9th, 2020. See the published version at https://doi.org/10.1186/s12955-020-01605-8. Page 1/11 Abstract Objective: By comparing psychometric properties of the SF-36 and the SF-12, supplied evidence for the election of instruments of the quality of life (QOL) and decision-making processes to promote the Quality of Life of adolescent. Methods: Stratied cluster random sampling was adopted. The Short-Form 36 (SF-36) was used to assess QOL. Pearson Correlation Coecient was used to show correlation. Cronbach’s Alpha and Construct Reliability (CR) were used to evaluate reliability of SF-36 and the Short-Form 12 (SF-12), Criterion Validity and Average Variance Extracted (AVE, Convergence Validity) for validity. Conrmatory factor analysis was used to calculate load factor for each item, then obtained CR and AVE. The Semejima grade response model (Logistic two-parameter module) in the item response theory was used to estimate the Item Discrimination, Item Diculty and Item Average Information of each item. Results: 19,428 samples were included in the study. The mean age was 14.78 years (SD=1.77). High correlations between corresponding domains and components of both scales were found. Reliability of sf-36 each domain was better than that corresponding domain of sf-12. Domains of PF, RP, BP, and GH in SF-36 had good construct reliability (CR,>0.6). The Criterion Validities of SF-36 were little higher in some corresponding dimensions except PCS. Convergence validities of SF-12 were higher than SF-36 in PF, RP, BP and PCS. The items of BP, SF, RP and VT in SF-12 had acceptable discriminations of items and higher than in SF-36. The items Average Amounts of Information of BP, VT, SF, RE and MH in SF-36 and SF-12 were poor. Conclusion: Two components (PCS and MCS) measurements of SF-12 appeared to perform at least as well as the SF-36 in cross-sectional settings in adolescence. Some domains, for instance SF and BP, were suitable for adolescents or not need study further. 1. Introduction Youth involved identity building; such experiences could shape their attributes and attitudes, leading to risky behaviors in their lives.[1] Due to individual experiences experiments and transformations, the determinants of health and disease for adolescence traversed the social and psychological elds [2]. A deeper understanding of how adolescents view their lives allowed a greater understanding of their health. Health- related quality of life of school adolescents in some international studies was discussed. ‘Health-related quality of life’ (HRQOL) was a comprehensive model of subjective health, which had covered physical, social, psychological and functional aspects of individual well-being as a multidimensional and subjective construct [3, 4]. For the purpose of guiding the organization of resources and decision-making processes to promote the quality of life of adolescent, Understanding the quality of adolescent's life was essential[5, 6]. the Short-Form 36(SF-36)was developed and validated as the most appropriate instrument to generic short form health survey for measuring Quality of Life (QOL), which was widely applied to assess important QOL domains in the Medical Outcomes Study[7]. The SF-36 consists of eight QOL domains (PF, physical functioning; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health) that comprise two summary measures-the physical component summary (PCS, calculated from PF RP, BP, and GH) and the mental component summary (MCS ,calculated from VT, SF, RE, and MH)[8]. One of the major advantages of using the SF-36 is that it allows for QOL scores to be compared to scores in different groups[9], However, because the SF-36 was not originally designed to measure important QOL domains specic to adolescent, some studies presented the SF-36, especially the mental component summary, to be relatively insensitive to variations in different populations over time[10–12]. A substantially shorter questionnaire, the SF-12 that was developed by Ware and colleagues utilized a reduced number of items from 36 to 12 for reducing the considerable burden placed on respondents and investigators generically by SF-36 [13, 14]. Most of respondents completed the SF-12 in less than a third of the usual time needed to complete the SF-36 [8]. Ware showed the two instruments highly correlated, and about 90% of the variation in both of the physical and mental component summary measures in the SF-36 was explained by the same summary measures of the SF-12[15]. Subsequent studies that compared the two scales had suggested varying results on account of the disease or health condition of interest. [16–18] The SF-12 and SF-36 were available in many languages, and were applied to all kinds of groups, including in adolescence[19]. Although studies had demonstrated that both scales were valid instruments for adolescent, they were rarely used to evaluate QOL of adolescent in china, In other words, few studies had focused on the quality of life of healthy adolescents in china[2, 20]. In adolescence, studies surveying the perception of QOL in chronic patients that conducted in hospital or outpatient settings were predominant [21, 22]. Otherwise, a recent interest in the study of healthy groups had accreted and been performed in other contexts, such as in school[23, 24], because it was benecial to recognizing and monitoring of adolescents vulnerable to a poor health-related quality of life[25, 26]. In some studies, though the SF-12 and SF-36 were used to investigate to the perception of QOL in adolescent, It was unclear which of the two scales was more suitable to adolescent[27]. Thus, our study aimed to evaluate the QOL of adolescent students at school in china by using the SF-36 and SF-12, through comparing psychometric properties of the SF-36 and the SF-12, supplying evidence for the election of instruments of the quality of life and decision- making processes to promote the quality of life of adolescent. Page 2/11 2. Methods 2.1 Study design and Sample Stratied cluster random sampling was adopted[28], rstly, dividing regions by geographical location, and Guangdong, Shanghai, Shenyang, Wuhan, Xi’an and Yunnan represented the south, east, north, central, northwest and southwest regions respectively. These areas were chosen in order to ensure proper representation by including participants from geographically diverse areas. Secondly, middle schools were randomly selected and followed by grade (First grade of junior school to third grade of high school), and all of students enrolled and effectively attending in the selected classes were eligible, except for those with any physical or mental condition that cannot complete questionnaires. The study was approved by the Institutional Review Board (IRB) at Aliated Hospital of Guangdong Medical University. Verbal informed consent was obtained for publication from the participants and/or their relatives as approved by the IRB. The response rate was almost 80%. This present study included the 19428 adolescents with complete information on quality of life measures. The sample sizes for each region were Guangdong (4490, 23.1%), Shanghai (1039, 5.3%), Shenyang (3539, 18.2%), Wuhan (1371, 7.1%), Xi’an (4197, 21.6%) and Yunnan (4792, 24.7%) 2.2 Instruments and variable SF-36 was used to assess QOL. Comprising eight subscales-physical functioning (PF), role functioning (RF), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role of emotional (RE) and mental health (MH), the rst four subscales constituted the physical component summary (PCS-36) among them, the remaining four subscales made up the mental component summary (MCS-36). Based on the response to individual items comprising that subscale and using a z-score transformation, Scores of each subscale are calculated. Using standard methods, aggregated to estimate physical and mental summary scores[29]. SF-12 component summary scores (eight subscales, PCS-12 and MCS-12) were calculated using SF-12 items embedded in the SF-36[30]. It had been presented to be equivalent to calculating SF-12 derived from the SF-12 as a standalone questionnaire[16]. All summary scores range from 0–100 where higher scores indicated better QOL. 2.3 Statistical analysis For descriptive analyses, we aimed to show overall demographics, and QOL. We calculated average and standard deviations in QOL scores by SF-36 and SF-12. For testing the relevance of them, Pearson Correlation Coecient was used to show correlation between subscales of SF-36 and SF-12. Cronbach’s Alpha and Construct Reliability (CR) were used to evaluate reliability of SF-36 and SF-12, and validity indicators were represented by criterion validity and average variance extracted (AVE). Conrmatory factor analysis was used to calculate load factor for each item, then obtained CR and AVE according to load factors. Criterion validity was expressed by the correlation between the response of each subscale and self-reported health status. According to the evaluation results of the samples, and taking into account the characteristics of the ordered and multi-category forms of the scale items, the Semejima grade response model (Logistic two-parameter module) in the item response theory was used to estimate the item discrimination, item diculty and item average information of each item[31].

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